Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We evaluated generic sodium stibogluconate (SSG) (International Dispensary Association, Amsterdam) versus Pentostam (sodium stibogluconate, GlaxoWellcome, London) under field conditions in Ethiopian patients with visceral leishmaniasis (VL; kala-azar). The 199 patients were randomly assigned to Pentostam (n = 104) or SSG (n = 95) in 1998/99; both drugs were given at 20 mg/kg intra-muscularly for 30 days. A clinical cure after 30-days treatment was achieved in 70.2% (Pentostam) and 81.1% (SSG). There were no significant differences between the 2 drugs for the following parameters: frequency of intercurrent events (vomiting, diarrhoea, bleeding or pneumonia) or main outcome (death during treatment and death after 6-month follow-up; relapse or post kala-azar dermal leishmaniasis at 6-months follow-up). Twenty-seven patients had confirmed co-infection with HIV. On admission, HIV co-infected VL patients were clinically indistinguishable from HIV-negative VL patients. The HIV co-infected VL patients had a higher mortality during treatment (33.3% vs 3.6%). At 6-month follow-up, HIV-positive patients had a higher relapse rate (16.7% vs 1.2%), a higher death rate during the follow-up period (14.3% vs 2.4%), and more frequent moderate or severe post kala-azar dermal leishmaniasis (27.3% vs 13.3%). Only 43.5% of the HIV-positive patients were considered cured at 6-months follow-up vs 92.1% of the HIV-negative patients. HIV-positive patients relapsing with VL could become a reservoir of antimonial-resistant Leishmania donovani.
 ...
PMID:Ethiopian visceral leishmaniasis: generic and proprietary sodium stibogluconate are equivalent; HIV co-infected patients have a poor outcome. 1181 42

The way in which the extensive use of highly active antiretroviral therapy (HAART) has influenced the incidence of visceral leishmaniasis (VL) among human immunodeficiency type 1 (HIV-1)-infected patients is not yet understood. The present study assessed whether the incidence of symptomatic VL in HIV-infected patients has decreased since the introduction of HAART. Likewise, the role of other potential risk factors for VL was also analyzed. Therefore, 479 HIV-1-infected patients receiving antiretroviral treatment, according to the available drugs at each moment, were prospectively followed from April 1989 to June 2000 in two university hospitals in southern Spain. A bone marrow aspiration was performed when patients showed symptoms suggestive of kala-azar. A diagnosis of VL was made when Leishmania amastigotes were seen in Giemsa-stained samples or promastigotes were cultured in specific media. The median follow-up time was 1,380 [8 to 4,536] days. Twenty-one patients were diagnosed with symptomatic VL. The density of incidence of VL has decreased 64.8% as of January 1997, when HAART began to be used extensively in our area. The use of HAART was the main independent factor associated with VL; this therapy was a protective factor (adjusted hazard ratio [HR], 0.05; 95% confidence interval [CI], 0.02 to 0.15). CDC clinical category C at entry in the cohort (HR, 4.08; 95% CI, 1.46 to 11.35) and CD4(+) cell counts below 300 cells/mm(3) during the follow-up (HR, 3.96; 95% CI, 1.56 to 10.01) were also independently associated with kala-azar. A VL diagnosis prior to follow-up and low compliance with antiretroviral therapy were not independently associated with symptomatic VL, although statistical significance was almost reached (P = 0.1 and P = 0.08, respectively). In summary, the use of HAART has led to a fall in the incidence of symptomatic VL in HIV-infected patients. The main risk factor associated with kala-azar emergence in patients infected with HIV is deep immunosuppression.
 ...
PMID:Incidence of and risk factors for symptomatic visceral leishmaniasis among human immunodeficiency virus type 1-infected patients from Spain in the era of highly active antiretroviral therapy. 1188 Mar 90

The clinical presentation of visceral leishmaniasis, or kala-azar, is variable but usually includes fever, severe cachexia, lymphadenopathy and hepatosplenomegaly. In immunocompromised patients the clinical course of the disease is even less specific and the diagnosis is often made by means of incidental detection of the parasites at atypical sites such as the gastrointestinal tract, peripheral blood, lungs and cerebrospinal fluid. We describe a case of pericardial leishmaniasis in an HIV-infected patient.
 ...
PMID:Visceral leishmaniasis with pericarditis in an HIV-infected patient. 1192 56

Visceral leishmaniasis (VL) is a systemic protozoan infection that infects a million people living in subtropical and tropical areas. Once established, the clinical course of untreated disease leads to death. Recent, large-scale epidemics in east Africa and India and the emergence of a new epidemic in patients infected with HIV makes VL a priority for the World Health Organization. Pentavalent antimonials have been the mainstay of the treatment for > 60years. The progressive appearance of antimonial resistance, the developments of lipid formulations of amphotericin B and a new oral administered drug (miltefosine) have changed the pattern of VL treatment. The prohibitive cost of new therapies leads to different treatment practices according to the socioeconomic and cultural status of each region.
 ...
PMID:Treatment of visceral leishmaniasis: a review of current treatment practices. 1215 Jun 89

Visceral leishmaniasis is common in less developed countries, with an estimated 500000 new cases each year. Because of the diversity of epidemiological situations, no single diagnosis, treatment, or control will be suitable for all. Control measures through case finding, treatment, and vector control are seldom used, even where they could be useful. There is a place for a vaccine, and new imaginative approaches are needed. HIV co-infection is changing the epidemiology and presents problems for diagnosis and case management. Field diagnosis is difficult; simpler, less invasive tests are needed. Current treatments require long courses and parenteral administration, and most are expensive. Resistance is making the mainstay of treatment, agents based on pentavalent antimony, useless in northeastern India, where disease incidence is highest. Second-line drugs (pentamidine and amphotericin B) are limited by toxicity and availability, and newer formulations of amphotericin B are not affordable. The first effective oral drug, miltefosine, has been licensed in India, but the development of other drugs in clinical phases (paromomycin and sitamaquine) is slow. No novel compound is in the pipeline. Drug combinations must be developed to prevent drug resistance. Despite these urgent needs, research and development has been neglected, because a disease that mainly affects the poor ranks as a low priority in the private sector, and the public sector currently struggles to undertake the development of drugs and diagnostics in the absence of adequate funds and infrastructure. This article reviews the current situation and perspectives for diagnosis, treatment, and control of visceral leishmaniasis, and lists some priorities for research and development.
 ...
PMID:Visceral leishmaniasis: current status of control, diagnosis, and treatment, and a proposed research and development agenda. 1267 59

Visceral leishmaniasis (VL), which is transmitted by sandflies, is always present in at least 62 countries and is spreading to areas where it had not existed in the past. VL/HIV co-infections are becoming more and more common. In southern Europe, 25-70% of adult VL cases also have HIV infection. 1.5-9% of AIDS cases have newly acquired or reactivated VL. In the Mediterranean area, VL is the most common opportunistic parasitic infection among AIDS cases (i.e., 100 CD4/mcl). AIDS patients with VL have a much shorter survival period than other AIDS patients. VL can lie dormant for years but emerge clinically if an infected person has immunosuppression. Most VL/HIV co-infections in the western hemisphere are in Brazil. East African countries reporting VL/HIV co-infections include Ethiopia, Kenya, Malawi, and Sudan. Only one VL/HIV co-infected case has been found in Cameroon and in Guinea Bissau. VL/HIV co-infection cases tend to not have the usual VL clinical signs and symptoms (fever, weight loss, hepatosplenomegaly, polyadenopathies), making clinical diagnosis difficult. Since VL test sensitivity in HIV positive patients is reduced 20-40%, it is also difficult to make a serological diagnosis. In the first VL episode of HIV-infected patients, clinicians should use BMA, the safest and most sensitive test. Drug options for VL treatment include pentavalent antimonials, pentamidine, amphotericin B, and amphotericin B encapsulated in liposomes. Treatment failure is rather common in VL/HIV co-infected patients. Researchers from different centers need to conduct trials of various multi-therapy schedules. 70% of VL/HIV co-infected cases in southern Europe use intravenous drugs, suggesting that sharing of needles may account for the co-infection. The World Health Organization has mobilized against VL/HIV co-infections, including setting up a minimal surveillance system.
 ...
PMID:Leishmania / HIV co-infections. 1229 May 65

This article presents an overview of the health situation in Bihar for the last 50 years. Although demographic improvements have been noted in the past years, the incidence of various diseases remains high and socioeconomic status low in Bihar. Protein-energy malnutrition, nutritional anemia and blindness are common. Safe drinking water and sanitary facilities are still not available to a large number of people. Furthermore, a number of communicable diseases are prevalent in the country. This is exemplified in the Kala-azar or visceral leishmaniasis epidemic in 1992, which reported 75,523 cases and 1417 deaths. Kala-azar cases have started rising again since 1996, and it is estimated that there might be another epidemic in the first decade of the 21st century if the situation is allowed to continue. Other infectious diseases, which threaten the health situation in Bihar, are malaria, tuberculosis, leprosy, and HIV/AIDS. Moreover, population and decadal growth rate have more than doubled over the last 40 years. Maternal mortality remains very high, but survival chances of children have increased due to immunization and other programs. In general, it was demonstrated that the present health situation in Bihar is a matter of grave concern, and requires an urgent solution.
 ...
PMID:Health in Bihar -- an overview. 1229 96

Sixty-six laboratory confirmed cases of Kala-azar from Uttar Pradesh attending various hospitals of Delhi over a period of 10 years (1989-1999) have been analysed. The geographical distribution showed that the disease involved widespread areas varying from a height of 10,000 ft. extending up-to the plains. Male, female ratio was 2:1 and maximum patients were in the age group of 5-15 years. L.D. bodies could be demonstrated in 59 patients in bone marrow aspirate smears while in 7 in splenic aspirate smears. One patient was co-infected with HIV. Indirect immuno fluorescent test was positive in 65 patients in titres ranging from 1:100 to 1:25,600 except in one HIV co-infected patient where no antibodies could be detected. Sixty-two (93.9%) patients responded completely to sodium stibogluoconate.
 ...
PMID:Kala-azar in Uttar Pradesh--a study of 66 patients. 1271 41

The visceral and the different spectrum of cutaneous leishmaniases have been incriminated to be among the opportunistic infections co-existing with HIV/AIDS. In co-infections, leishmaniases surface in high prevalence, present frequently atypically, pose difficulties to be detected by routine diagnostic tests, most often result in an unfavorable response to treatment, frequent relapses and in premature deaths. Such presentations and management difficulties shall be highlighted in this review. To extract information on the scope of manifestations and responses to management, literature was surveyed utilizing the Pub Med electronic literature search. In due course, pertinent characteristics surfacing in HIV/AIDS and leishmaniasis co-infections comprising of clinical presentations and parasitological and serological findings were tracked. Investigation options, management approaches, outcomes of various treatment regimen and other intervention strategies were as well explored. Visceral leishmaniasis and HIV-1 are both associated with a depression of T cell response and similar disturbances of cytokine networks. The appearance of HIV has led to numerous atypical clinical manifestations of leishmaniasis among immunocompromised patients to include, recurrences, lingual, cervical, esophageal, mucocutaneous and presentations in other unusual sites. The common clinical presentations of the disease might not always be present being masked by other associated opportunistic infections. Spleen aspiration is more sensitive in immuno-competent visceral visceral leishmaniasis suspects, however, bone marrow aspirate remains the safest and the most frequently employed diagnostic technique in co-infected patients. Several species of Leishmania are incriminated in affecting HIV infected subjects, including formerly unknown zymodemes. In spite of the high number of reported cases of HIV-related VL, the treatment of choice, the best dosage and the duration of therapy appear not to be properly established. The pentavalent antimonials still remain the first line of therapy for co-infected cases. Amphotericin-B, especially the liposome formulation (Ambisome) was found to be relatively less toxic and more potent compared to pentamidine. A broad spectrum of other drugs have as well been used. The widespread use of HAART are envisaged to contribute to a progressive decrease in the morbidity and mortality of HIV-associated visceral leishmaniasis. There is no effective chemoprophylaxis or immuno-prophylaxis to prevent leishmanial infection. In the events of co-infections with HIV/AIDS, the need for policy provisions to control both diseases needs to be underlined. It is as well of a paramount importance that factors influencing co-infection are understood for effective treatment against leishmaniasis in co-infected patients. The need for improved diagnostic tests and new more effective and less toxic drugs is also apparent.
 ...
PMID:Leishmaniases and HIV/AIDS co-infections: review of common features and management experiences. 1280 30

Visceral leishmaniasis (VL) is generally associated with severe immunodeficiency (AIDS; renal, liver, and heart transplantations; haemopoietic malignancies). More rarely it can be related to an immunotolerence status such as pregnancy. Various observations report the development of leishmaniasis several months or even years after exposure to the parasite. Relapses occur rarely in patients not known to be immunocompromised, but are common after incomplete treatment. They are frequent in patients with Leishmania/HIV co-infection. Asymptomatic phases and relapses suggest that parasite can exist in the tissues for a long time before and/or after clinical onset of the disease. The mechanisms of onset of clinical leishmaniasis following exposure and infestation are highly relevant to understanding the pathology of the disease. The survival of Leishmania parasite between infection and disease or after cure is a very important issue for clinicians and epidemiologists. We describe two cases of VL occurring in a patient with lymphoma and in a pregnant woman. In both cases, parasites remained present in the lymph nodes after clinical cure.
 ...
PMID:Visceral leishmaniasis. Persistence of parasites in lymph nodes after clinical cure. 1285 Jan 67


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>